Israeli eye surgeons restore sight to patients in developing world

‘When we take off the bandages… they’re looking at each other crying; these are the kinds of images I can never forget. It’s something amazing’ – Dr. Emmanuel Schwalb.When Israeli eye surgeon Dr. Emmanuel Schwalb landed in a remote corner of Uzbekistan four years ago, he did not know what to expect. The Beer Sheba Medical Center doctor was there to perform surgery for cataracts and other eye injuries but was stunned by the severity of eye damage and primitive medical equipment he encountered.

But now he and colleague Dr. Dan Sachs are seasoned veterans, literally bringing ‘sight to the blind’ in their travels.

The two surgeons undertook their missions as part of MASHAV, a program operated by Israel’s Ministry of Foreign Affairs Center for International Cooperation. Founded in 1960, MASHAV brings Israeli expertise in medicine, agriculture and other fields to countries in the developing world.

Schwalb’s first MASHAV mission took him to a rural area of southern Uzbekistan along the Afghan border. “We met the third world there – cases we don’t see here [in Israel],” the Romanian-born surgeon told ISRAEL21c. “Cases were much more difficult than normal surgery [in Israel], because when cataracts are not operated on at the appropriate time, they get harder. Most of the patients were blind from cataracts.”

Schwalb and Sachs, head of Tel Hashomer Medical Center’s Cataract Department in Tel Aviv, have traveled together three times under the MASHAV umbrella: twice to Uzbekistan and once to Palau, Micronesia. While overseas, each doctor performs seven to nine cataract surgeries per day totaling more than 100 operations in two weeks overseas. They work in local settings ranging from basic to advanced.

“[In Uzbekistan] it’s a hospital with fifty-year-old instruments,” explains Schwalb, “[In Israel] we can’t find those kinds of microscopes in a museum!”

On the other hand, in the former U.S. territory of Micronesia there are high tech instruments but no doctors to perform the crucial surgeries. In both cases the doctors arrive with the aim of helping as many patients as possible during their two-week stay.

The specific nature of cataracts surgery renders the results of their missions even more astonishing because Schwalb and Sachs are doing what few doctors have an opportunity to accomplish: bring sight to the blind.

“Here, [in Israel] most of our patients can see partially but they can’t read or can’t drive so we do the surgery to improve the quality of life. There surgery is done to turn a blind man into a seeing man,” said Schwalb, describing the feeling as extraordinary.

“The day after surgery when we take off the bandages, they’re looking at each other crying -these are the kinds of images I can never forget. It’s something amazing.”

Cataracts are eye conditions generally brought on by aging or a traumatic accident. The eye’s clear lens which helps with focusing on images or adjusting to light becomes opaque or cloudy blurring vision.

“It’s like having a dirty window in front of the retina,” says Schwalb. If the condition is left untreated, the cataract continues to worsen ultimately leading to blindness. In the developed world most people treat cataracts before sight is lost. However, Schwalb explains, in the developing world untreated cataracts is the leading cause of blindness.

Cataract surgery involves removing the opaque lens and replacing it with an artificial lens. The patients treated by Schwalb and Sachs have lived with the untreated condition for such a lengthy period that surgery is more difficult than usual. In turn, this specific type surgery has become a sub-specialty of sorts for doctors who rarely, if ever, would encounter such advanced cases.

For both Sachs and Schwalb the opportunity to work in the third world has been a very special experience.

“I wanted to do something without being paid for it,” explains the Egyptian-born Sachs. “Something only for the people of the world who can’t go to the hospital or get medicine. It’s something for the soul.”

Schwalb concurs. “I think this mission takes us back to being in university to doing what surgeons love to do. It’s very exciting.”

While overseas the doctors also treat accident related eye injury cases, often children. These complicated surgeries tend to necessitate general anesthesia and the bulk of patients treated have suffered corneal perforation. In response, say the doctors, local communities have been very positive towards the two.

“Uzbekistan is a Moslem country,” explains Schwalb, “so we were surprised by the kindness of the people and the good words they had for Israeli doctors. There was no talk of war or of fear but just admiration for the Israeli people and government that sent us. Just gratefulness to Israel. It was a very nice feeling.”

Sachs recalls their Uzbekistan experience somewhat differently. “[At first] they thought we were different being Jewish, being Israelis. But they saw that we were just like everybody. This is something very special.”

The doctors’ most recent mission was to a remote region of Eastern Uzbekistan last year. While there they were visited by a surprise guest.

“We were in the hospital, looking at patients and we heard someone knocking. A man entered and started speaking. He couldn’t speak Hebrew, English, Yiddish, but he pointed to his chest, and said ‘Rosenzweig’,” remembers. Sachs. “Then he took out a calendar from 1994 from the Sochnut (Jewish Agency), he showed it to us and said, ‘Jew, Jew’.”

As fate would have it, the lone Jew in the region had come to pay respects to the Israeli team. Because of language barriers the physicians were unable to understand much of Rosenzweig’s life tale. But they were moved by his visit regardless.

In addition to sending doctors overseas, the MASHAV program also brings doctors from abroad to get hands-on training in Israel’s hospitals. Doctors from Cameroon and Uzbekistan have already arrived, and according to Sachs, more are slated to arrive in the future.

Sachs says the role of these types of missions cannot be overestimated. “I think this is important for every doctor personally and for Israel’s image in the world,” he says.

“I admire this project,” he continues. “Israel is not a rich country. We have lots of problems and a continuous war. MASHAV sends a lot of missions and each mission costs at least $15,000. But I don’t know of another state that does the same.”